摘要
目的结合文献总结肝脏移植术后淋巴增生性疾病(PTLD)的临床诊疗经验。方法回顾性分析笔者所在医院2011年1月至2015年10月期间收治的3例肝脏PTLD患者的临床诊治过程并复习国内外相关文献。结果 3例患者均系肝脏移植术后EB病毒阴性,CD20(+),发病时间均为肝脏移植术后10+年,最长为12年,术后均给予他克莫司抗免疫排斥治疗。其中1例在发现PTLD后10个月死亡,2例仍在化疗过程中,目前情况稳定。病理诊断均为弥漫性大B细胞淋巴瘤。结论随着大量免疫抑制剂的使用,肝脏PTLD的发病率呈逐渐上升的趋势,且预后较差,早期诊断困难。目前确诊和分类依然依赖于病理学检查。EB病毒阳性的患者大多发病较早,而EB病毒阴性的患者虽发病较晚,却预后较差,故应长期随访,争取早期发现,对于CD20(+)的患者可以给予利妥昔单抗治疗。
Objective To summarize experience of clinical diagnosis and treatment for liver posttransplant Iymphoproliferative disorder （PTLD）. Method The clinical diagnosis and treatment processes of 3 patients with live PTLD in this hospital were retrospectively analyzed and the relevant literatures were reviewed. Results The EB virus was negative and CD20 was positive for these 3 patients with liver PTLD, the time of onset was 10 to 12 years after liver transplantation, and the tacrolimus was given for anti-immune following liver transplantation. The pathological diagnosis was diffuse large B cell lymphoma for all the patients. Conclusions With use of large quantities of immunosuppressive drugs following liver transplantation, incidence of liver PTLD gradually rises. Meanwhile, prognosis is poor and early diagnosis is difficult. Currently, diagnosis and classification is still dependent on pathological examination. EB virus positive patients show earlier onset, while EB negative patients show later onset with a poorer prognosis. Therefore, a long- term follow-up should be conducted for early detection, and rituximab should be administrated to oatients with CD20 （＋）.
出处
《中国普外基础与临床杂志》
CAS
2015年第12期1443-1446,共4页
Chinese Journal of Bases and Clinics In General Surgery
